Walkthrough: Pharmacological and Parenteral Therapies Q4 – NCLEX-RN®

00:01 A client has been taking oxycodone for pain for several weeks.

00:05 Which sign indicates to the nurse that the client might have developed a tolerance to the drug.

00:11 Okay, so, we know they've been on oxycodone, that's a drug we're talking about. Right? So what type of med is that? It's an opioid for pain. That makes sense.

00:21 They've been on it for a while.

00:23 So which sign indicates the nurse that the client might have developed tolerance? What does that mean? Well, when the body builds up a tolerance, the same dosage doesn't have the same level of effectiveness for them anymore.

00:37 So, now, let's look at the answer choices.

00:40 There we go. Just four, right? This is just one of the answer. We're not a select all that apply.

00:46 This is just what is the most correct answer.

00:49 Please write down 1, 2, 3, 4.

00:52 Pause the video.

00:53 Walk through each of these answer choices, eliminate instead of gravitating and say why on each question, then start the video again, and we'll walk through it together.

01:12 So I'm looking for something that indicates tolerance.

01:14 So, would number one indicate tolerance? The medication is just as effective as it was at the beginning.

01:23 Nope. Because the work we did and the topic of the question, we know that tolerance means it's not as effective.

01:29 So number one is out.

01:31 Number two, the client no longer gets constipated when taking oxycodone.

01:37 Now, that's a whole another issue. That isn't tolerance.

01:39 So, no. In fact, really, tolerance to constipation doesn't really occur.

01:44 If a patient has a problem with opioids, that problem lingers, unfortunately.

01:50 So one and two, they're out.

01:52 Number three.

01:53 The client has withdrawal symptoms when stopping the medication.

01:58 Is that tolerance? No.

02:01 That means, they didn't wean the medication.

02:04 And because they've been on it for several weeks.

02:06 Wow. That's why they had withdrawal symptoms.

02:09 So it's so important in a CNS medication, like a pain medication and opioid that you work with the healthcare provider to slowly wean.

02:18 Gradually take smaller and smaller doses, with longer periods of time in between those doses, so the body can adjust to the change.

02:27 So we've eliminated 1, 2, 3.

02:29 I hope in four works.

02:31 The client asked for the medication more often.

02:34 That means tolerances build up.

02:37 Before when they started the medication, maybe the patient could go every six to eight hours, and they had enough relief and pain control.

02:44 But now, they're starting to really feel that pain revved up before that six to eight hours.

02:51 That's why they're asking for it more often.

02:53 That would be an indication that the patient has built up a tolerance.

02:57 Now we have an opioid crisis in the United States.

03:00 They were over prescribed for a period of time in our history, but they have a place in healthcare.

03:07 So don't assume that someone who's requesting treatment for pain is just seeking drugs.

03:14 Sometimes health care providers have a real bias against that.

03:17 Remember, pain in practice.

03:20 And in NCLEX is what the patient reported to be.

03:25 If you sense there's some type of problem or other issue going on, maybe you sense there could be an underlying addiction issue that is outside of the scope of a nurse, right.

03:36 That's outside of our scope of practice.

03:38 So you need to make the appropriate referral with the healthcare provider to get the patient the help they need and deserve.

03:45 Okay, good job.

03:46 Now you're ready for the next question.